Mental disorders associated with JE
Introduction
Introduction to mental disorders associated with JE Mental disorder associated with epidemic encephalitis (JE) refers to central nervous system infectious diseases caused by Japanese encephalitis virus transmitted by mosquito vectors, and mental disorders appearing on this basis, epidemic Japanese encephalitis is often prevalent in summer and autumn. It has a sharp onset and occurs in children. The lesion is in the brain parenchyma, with extensive inflammation as the main pathological change. In recent years, the incidence rate has dropped significantly, and the mortality rate is less than 15%. About 1/4 of critically ill patients may have neuropsychiatric symptoms. basic knowledge The proportion of sickness: 0.01% Susceptible people: good for children Mode of infection: mosquito vector infection Complications: bronchial pneumonia oral ulcer acne
Cause
Causes of mental disorders associated with JE
(1) Causes of the disease
It is an acute infectious disease of the central nervous system caused by the Japanese encephalitis virus (a neurotropic virus) transmitted by mosquito vector.
(two) pathogenesis
The majority of acute inflammation of the brain parenchyma, especially the cerebral cortex, midbrain, pons, basal ganglia and medulla, heavier, visible hyperencephalic vascular enlargement and hyperemia, and due to congestion, edema and increased intracranial pressure Hippocampal palsy or cerebellar tonsil sputum may occur, which often leads to death of the patient. Degeneration and necrosis of nerve cells, glial cell proliferation and perivascular inflammatory cell infiltration are observed under the microscope.
Prevention
JE concomitant mental disorder prevention
Epidemic encephalitis B is an acute infectious disease caused by Japanese encephalitis virus and transmitted by mosquitoes. It is one of the main infectious diseases that threaten people's health, especially children's health. The epidemic season of Japanese encephalitis is summer and autumn, and the key to prevention is It is a fundamental measure to prevent JE and control the epidemic before the arrival of this season. Vaccination is an effective measure to protect susceptible populations, because pigs are the main intermediate host for JE transmission. It is also necessary to strengthen the management of animal hosts, effectively reduce the incidence of Japanese encephalitis, and reduce the mental disorders associated with epidemic encephalitis. In order to prevent and control the work, reduce the incidence of Japanese encephalitis, and protect people's health and health. The Ministry of Health issued the "Guiding Opinions on the Prevention and Control of Epidemic Encephalitis B" (Wei Disease Control [2004] No. 75), which is a programmatic document to prevent this disease.
Mainly to prevent the primary disease. Effectively reducing the incidence of Japanese encephalitis can reduce the mental disorder associated with epidemic encephalitis.
The epidemic season of Japanese encephalitis is summer and autumn. The key to prevention is to get rid of mosquito killing work before the arrival of this season.
Vaccination is an effective measure to protect vulnerable populations. In our country, the inactivated vaccine made by hamster kidney tissue culture is used. After the season test, the protection rate can reach 60%-90%.
Because pigs are the main intermediate host for JE transmission, vaccines have been used to immunize young pigs in recent years to reduce viremia in pigs.
Complication
JE concomitant complications of mental disorders Complications, bronchopneumonia, oral ulcer, acne
1. Bronchial pneumonia is more common in severe patients, and is prone to pneumonia in patients with cough and swallowing reflexes that are weakened or disappeared and comatose. Atelectasis can be caused when the secretions of the respiratory tract cannot be discharged smoothly.
2. Patients with oral infections who do not pay attention to oral hygiene and who do not have oral care may develop oral ulcers.
3. Other septicemia and enteritis caused by Staphylococcus aureus, urinary tract infection caused by Escherichia coli.
4. Patients with hemorrhoids staying in bed for a long time, if they do not pay attention to change their position frequently, it is easy to develop hemorrhoids in the posterior occipital and lumbar vertebrae.
Symptom
Symptoms of mental disorders associated with Japanese encephalitis Common symptoms Abdominal pain irritating psychomotor excitement Nausea and vomiting Diarrhea High fever Forgetful convulsions Respiratory failure coma
1. The incubation period of physical symptoms is generally 10 to 14 days.
(1) Initial stage: The onset is within 1 to 3 days, the onset is urgent, the main symptom is fever, the body temperature can reach 39 ~ 40 °C within 1 to 2 days, accompanied by headache, nausea and vomiting, abdominal pain, diarrhea and mild disturbance of consciousness, such as Burnout, lethargy, etc.
(2) Extreme period: on the 4th to 10th day of onset, mainly manifested as high fever, convulsions, coma, respiratory failure, etc., the signs of the nervous system usually reach a peak within 1 week, visible tremor, convulsions, various sputum, sputum reflex disappears , cranial nerve disorders, meningeal irritation and autonomic dysfunction, urinary incontinence or urinary retention.
(3) Late stage: may be left with dullness, hooliganism, aphasia or slurred speech, tremor, ataxia, varying degrees of paralysis or manifestation of simple disturbance of consciousness, acromegaly, epileptic seizures or Jackson epilepsy, at this time the patient May be associated with epilepsy, Parkinson's syndrome is lighter, and can be improved, some patients have speech disorders, manifested as not speaking, stuttering or pinyin is not clear, etc., generally recovered in 6 months, a few last longer .
2. Psychiatric symptoms The severity of mental symptoms, the length of the disease varies according to the primary disease, generally speaking, with the recovery of physical symptoms and getting better, a few can last for 1 to 2 years; or with the emergence of disease sequelae and chronic symptoms of mental symptoms.
(1) Early or acute symptoms:
1 disturbance of consciousness: visible disturbance of consciousness of various degrees (from turbidity to coma), at this time the orientation force is incomplete, and there may be exercise excitement.
2 Illusion delusion state: the patient is in a state of no desire and weakness, the thinking is slow or incoherent, the expression is dull, the movement is less and slower, and the delusion is more on the basis of hallucinations, more common in adults, and more often in mild disturbance of consciousness.
3 Perceptual comprehensive obstacles: Some patients have obvious visually large objects, small visual objects, visual distortions and complex obstacles in body shape perception, all of which are generated on the basis of disturbance of consciousness.
4 tension syndrome: more common in children, a small number of patients may have brain weakness syndrome, as well as insomnia, forgetfulness, dull expression, emotional dullness or irritability, distraction and other symptoms.
(2) Late or chronic mental symptoms:
1 Personality changes: patients become naive, easy to impulsive, attack people, retaliate against others, emotional instability or lack of restraint, some lack initiative and due emotional response, willing activity is weakened, lonely, rigid, and some Patients become selfish and easy to remember, and some patients show behavior as rash, become frivolous, sexual intentions increase, steal, lie, etc., more common in adults.
2 Intelligent barriers: It is often the main cause of mental retardation. In the early stage of the disease, children with severe illnesses are more common, and the degree of dementia is heavier and the recovery is poor.
3 Behavioral abnormalities: more common in children, performance is good, impulsive, hilarious, destructive behavior and hand and foot, sputum and so on.
Examine
Examination of mental disorders associated with JE
Conforms to the laboratory test for infectious Japanese encephalitis. The results of the examination related to epidemic encephalitis B.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with JE
Diagnostic criteria
Generally, it can be diagnosed according to medical history, physical signs and laboratory tests (see the relevant section of the Infectious Diseases Section) and with reference to the popular season (more in summer and autumn).
1. Acute onset, clear onset season and infection history.
2. Clear physical symptoms and signs of the nervous system, such as high fever, meningeal irritation and so on.
3. Psychiatric symptoms are mainly caused by disturbance of consciousness, which may be accompanied by psychomotor excitement, hallucinations, delusions, perceptual comprehensive disorders and tension syndrome. The symptoms of the remaining are mainly personality changes, mental disorders and behavioral abnormalities.
4. Laboratory examination showed elevated cerebrospinal fluid pressure, elevated white blood cells, complement fixation test, and serum antibody test positive.
Differential diagnosis
1. Patients with obvious mental symptoms should be differentiated from functional psychosis such as schizophrenia. The identification points are mainly the presence or absence of physical symptoms and signs, and the degree of disturbance of consciousness.
2. Symptoms of sequelae Adults mainly change personality, children often see intelligent changes, behavior changes, etc. Before the appearance of mental symptoms, there is a clear history of infection of infectious diseases.
3. Differentiation from other brain organic diseases
(1) Identification of disturbances of consciousness: epidemiological characteristics, clinical manifestations and laboratory tests can distinguish the disturbances of consciousness that occur in different brain organic diseases.
(2) Identification of type A encephalitis: clinically, it should be differentiated from type A encephalitis. Parkinson's syndrome of type A encephalitis is more common and more serious, and may have a temporary deterioration, when encephalitis B Parkinson's syndrome is mild, tremor, autonomic symptoms, pupillary disorders and other symptoms are less, the trend of improvement is also more obvious, and personality changes, Japanese encephalitis and nail encephalitis are different, type B encephalitis It is non-progressive and lighter. The above differences are mainly due to the serious and progressive pathological changes of substantia nigra in Japanese encephalitis. In addition, there are more serious mental retardation in the sequela of Japanese encephalitis. See, Zhang mouth reflex, strong grip reflex and other original movements are also common, , chorea is more common in Japanese encephalitis, and the degree of mental retardation after A-type encephalitis is mild, mostly moderate or mild.
